1. (a) Subscribers may be reimbursed up to a total of one hundred and twenty-five dollars ($125.00) for pregnancy-related medically necessary services, including but not limited to pregnancy test and initial prenatal visit, received in the time period beginning forty (40) calendar days prior to the application date that a complete application is received by the program and ending on the beginning date of coverage.

2. (b) Requests for payment pursuant to this section shall be submitted by the subscriber within ninety (90) calendar days of the date service was provided and shall include the following information:

   1. (1) An original bill which includes the name and business address of the medical doctor, doctor of osteopathy, registered nurse, pharmacist or physician's assistant, or laboratory providing the service,
   2. (2) Name, address, date of birth and social security number (not mandatory) of the subscriber for whom services were provided,
   3. (3) Date service was provided,
   4. (4) Type of service provided,

Note: Authority cited: Section 12696.05, Insurance Code. Reference: Section 12698.25, Insurance Code.

History

1. New section filed 12-12-91 as an emergency; operative 12-12-91 (Register 92, No. 10). A Certificate of Compliance must be transmitted to OAL 4-10-92 or emergency language will be repealed by operation of law on the following day.

2. Certificate of Compliance as to 12-12-91 order transmitted to OAL 4-8-92 and filed 5-20-92 (Register 92, No. 21).

3. Amendment of subsections (b)-(b)(1) and repealer of subsection (b)(5) filed 8-29-94 as an emergency; operative 9-1-94 (Register 94, No. 35). A Certificate of Compliance must be transmitted to OAL by 12-30-94 or emergency language will be repealed by operation of law on the following day.

4. Certificate of Compliance as to 8-29-94 order transmitted to OAL 12-9-94 and filed 1-23-95 (Register 95, No. 4).

5. Amendment filed 5-20-2003; operative 5-20-2003 pursuant to Government Code section 11343.4 (Register 2003, No. 21).